ANCC Adult-Gerontology Primary Care Exam Questions
and Answers with Rationales 2026/2027 Update
1. A 68-year-old patient with hypertension has an office BP of 168/92
mmHg. Which finding most strongly supports a diagnosis of sustained
hypertension?
A. One elevated reading after exercise
B. Repeated elevated measurements obtained correctly on separate
occasions
C. A single elevated home reading
D. Mild anxiety during the visit
Answer: B
Rationale: Hypertension is diagnosed using appropriately obtained
elevated measurements confirmed across separate occasions or
through validated out-of-office monitoring.
2. Which intervention is most appropriate for a patient with newly
diagnosed stage 1 hypertension and low cardiovascular risk?
A. Immediate combination pharmacotherapy
B. Lifestyle modification and reassessment
C. Loop diuretic therapy
D. Long-term beta-blocker monotherapy
Answer: B
Rationale: In patients with lower cardiovascular risk, initial lifestyle
interventions may be appropriate before medication depending on BP
level and overall risk.
3. Which lifestyle change generally has the greatest effect on reducing
blood pressure in a patient with overweight or obesity?
A. Increasing dietary sodium
B. Weight reduction
,C. Avoiding all carbohydrates
D. Increasing saturated fat intake
Answer: B
Rationale: Weight loss can produce clinically meaningful reductions in
blood pressure and improves several cardiovascular risk factors.
4. A patient taking lisinopril develops facial swelling and difficulty
breathing. What is the priority action?
A. Give the next dose with food
B. Continue therapy and monitor
C. Treat as angioedema and discontinue the ACE inhibitor
D. Substitute another ACE inhibitor
Answer: C
Rationale: ACE inhibitors can cause potentially life-threatening
angioedema. The medication should be discontinued and emergency
treatment initiated when airway compromise is possible.
5. Which electrolyte abnormality is most associated with thiazide
diuretics?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B
Rationale: Thiazides increase urinary sodium and potassium loss and
can cause hypokalemia.
6. Which medication class is particularly useful for hypertension in a
patient with diabetes and albuminuria?
A. ACE inhibitor or ARB
B. Nitrate
,C. Alpha-agonist
D. Loop diuretic alone
Answer: A
Rationale: ACE inhibitors and ARBs reduce intraglomerular pressure
and albuminuria and provide renal protection in appropriate patients.
7. A patient reports exertional substernal chest pressure relieved by
rest. This presentation is most consistent with:
A. Stable angina
B. Pleurisy
C. Acute pericarditis
D. Gastroenteritis
Answer: A
Rationale: Predictable exertional chest discomfort relieved by rest is
characteristic of stable angina.
8. Which symptom in a patient with chest pain requires immediate
emergency evaluation?
A. Pain lasting several seconds
B. Reproducible tenderness only
C. New chest pressure with diaphoresis and dyspnea
D. Mild discomfort after a large meal
Answer: C
Rationale: New pressure-like chest pain accompanied by autonomic or
respiratory symptoms can represent acute coronary syndrome.
9. Which medication is commonly used for secondary prevention after
myocardial infarction unless contraindicated?
A. Aspirin
B. Antacid
, C. Benzodiazepine
D. Antihistamine
Answer: A
Rationale: Antiplatelet therapy with aspirin is a foundational
component of secondary cardiovascular prevention when appropriate.
10. Which lipid abnormality is the primary target of statin therapy?
A. Elevated LDL cholesterol
B. Low sodium
C. Elevated bilirubin
D. Low albumin
Answer: A
Rationale: Statins primarily reduce LDL cholesterol and cardiovascular
risk.
11. A patient taking a statin reports severe unexplained muscle pain
and weakness. Which laboratory test is most appropriate when
significant myopathy is suspected?
A. Creatine kinase
B. Amylase
C. Troponin only
D. INR
Answer: A
Rationale: Creatine kinase can help evaluate suspected statin-
associated muscle injury.
12. Which finding is most characteristic of heart failure with volume
overload?
A. Peripheral edema and elevated jugular venous pressure
B. Dry mucous membranes only
and Answers with Rationales 2026/2027 Update
1. A 68-year-old patient with hypertension has an office BP of 168/92
mmHg. Which finding most strongly supports a diagnosis of sustained
hypertension?
A. One elevated reading after exercise
B. Repeated elevated measurements obtained correctly on separate
occasions
C. A single elevated home reading
D. Mild anxiety during the visit
Answer: B
Rationale: Hypertension is diagnosed using appropriately obtained
elevated measurements confirmed across separate occasions or
through validated out-of-office monitoring.
2. Which intervention is most appropriate for a patient with newly
diagnosed stage 1 hypertension and low cardiovascular risk?
A. Immediate combination pharmacotherapy
B. Lifestyle modification and reassessment
C. Loop diuretic therapy
D. Long-term beta-blocker monotherapy
Answer: B
Rationale: In patients with lower cardiovascular risk, initial lifestyle
interventions may be appropriate before medication depending on BP
level and overall risk.
3. Which lifestyle change generally has the greatest effect on reducing
blood pressure in a patient with overweight or obesity?
A. Increasing dietary sodium
B. Weight reduction
,C. Avoiding all carbohydrates
D. Increasing saturated fat intake
Answer: B
Rationale: Weight loss can produce clinically meaningful reductions in
blood pressure and improves several cardiovascular risk factors.
4. A patient taking lisinopril develops facial swelling and difficulty
breathing. What is the priority action?
A. Give the next dose with food
B. Continue therapy and monitor
C. Treat as angioedema and discontinue the ACE inhibitor
D. Substitute another ACE inhibitor
Answer: C
Rationale: ACE inhibitors can cause potentially life-threatening
angioedema. The medication should be discontinued and emergency
treatment initiated when airway compromise is possible.
5. Which electrolyte abnormality is most associated with thiazide
diuretics?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B
Rationale: Thiazides increase urinary sodium and potassium loss and
can cause hypokalemia.
6. Which medication class is particularly useful for hypertension in a
patient with diabetes and albuminuria?
A. ACE inhibitor or ARB
B. Nitrate
,C. Alpha-agonist
D. Loop diuretic alone
Answer: A
Rationale: ACE inhibitors and ARBs reduce intraglomerular pressure
and albuminuria and provide renal protection in appropriate patients.
7. A patient reports exertional substernal chest pressure relieved by
rest. This presentation is most consistent with:
A. Stable angina
B. Pleurisy
C. Acute pericarditis
D. Gastroenteritis
Answer: A
Rationale: Predictable exertional chest discomfort relieved by rest is
characteristic of stable angina.
8. Which symptom in a patient with chest pain requires immediate
emergency evaluation?
A. Pain lasting several seconds
B. Reproducible tenderness only
C. New chest pressure with diaphoresis and dyspnea
D. Mild discomfort after a large meal
Answer: C
Rationale: New pressure-like chest pain accompanied by autonomic or
respiratory symptoms can represent acute coronary syndrome.
9. Which medication is commonly used for secondary prevention after
myocardial infarction unless contraindicated?
A. Aspirin
B. Antacid
, C. Benzodiazepine
D. Antihistamine
Answer: A
Rationale: Antiplatelet therapy with aspirin is a foundational
component of secondary cardiovascular prevention when appropriate.
10. Which lipid abnormality is the primary target of statin therapy?
A. Elevated LDL cholesterol
B. Low sodium
C. Elevated bilirubin
D. Low albumin
Answer: A
Rationale: Statins primarily reduce LDL cholesterol and cardiovascular
risk.
11. A patient taking a statin reports severe unexplained muscle pain
and weakness. Which laboratory test is most appropriate when
significant myopathy is suspected?
A. Creatine kinase
B. Amylase
C. Troponin only
D. INR
Answer: A
Rationale: Creatine kinase can help evaluate suspected statin-
associated muscle injury.
12. Which finding is most characteristic of heart failure with volume
overload?
A. Peripheral edema and elevated jugular venous pressure
B. Dry mucous membranes only
